Implementing Process Improvement In Healthcare
By Gagan Rajpal With Craig A. Stevens PMI Nashville Symposium 2013 gaganrajpal1@gmail.com craigastevens@westbrookstevens.com
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Agenda Creating a Team Focused Improvement Program
✓
1
Goals/Objectives
2
General PI Processes
3
PI Assessment andtext. Performance This is an example Go aheadMeasures and replace it
4
Process Analysis
5
Layout Analysis and Spaghetti Diagrams
6
Value Chain Analysis
7
SPIOC
8
Summary of PI Program Approach
craigastevens@westbrookstevens.com
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craigastevens@westbrookstevens.com
Implementing Process Improvement In Healthcare •
Process Improvement is all about implementing changes; many times these are small, requiring no project management. However, other improvements require major changes that become projects. The biggest problem with many of the process improvement programs is that you have to have a degree in statistics or engineering to understand them. However, it does not have to be that way. During this presentation, we will apply a simple threephase Process Improvement process using PM, LEAN, Six Sigma, and TQM approaches to real Healthcare examples as applied by University of Tennessee’s Industrial and Systems Engineering Department.
1/7/2013
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craigastevens@westbrookstevens.com
Goals and Objectives This Presentation Improvement Focused Teams
• Reinforce the Simple Three Phases • To Show Some Examples of Process Improvement using Healthcare
craigastevens@westbrookstevens.com
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Agenda Creating a Team Focused Improvement Program
✓
1
Goals/Objectives
✓
2
General PI Processes
3
PI Assessment andtext. Performance This is an example Go aheadMeasures and replace it
4
Process Analysis
5
Layout Analysis and Spaghetti Diagrams
6
Value Chain Analysis
7
SPIOC
8
Summary of PI Program Approach
craigastevens@westbrookstevens.com
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Three Easy to Understand and Use Improvement Phases A= Assessments
P = Problem Solving
I = Implementation Using Project Management Tools/Support
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Westbrook Stevens, Seven Attributes of Excellent Management Model, 1990 Š
People and Team Building
From Book Geronimo Stone http://www.llumina.com/store/geronimostone2.htm
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Step 1 –Build the Assessment Candidate Portfolio
craigastevens@westbrookstevens.com
Life cycle of a patient needing services at East Tennessee Children Hospital Resource Allocation
Hospital Service
Patient Admissions
Doctor’s Office/ Department
Incoming Patients
gaganrajpal1@gmail.com
Step 2 –Assessment Phase
A= Assessments
P = Problem Solving
I = Implementation Using Project Management Tools/Support
craigastevens@westbrookstevens.com
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Agenda Creating a Team Focused Improvement Program
✓
1
Goals/Objectives
✓
2
General PI Processes
✓
3
PI Assessment and Performance Measures This is an example text. Go ahead and replace it
4
Process Analysis
5
Layout Analysis and Spaghetti Diagrams
6
Value Chain Analysis
7
SPIOC
8
Summary of PI Program Approach
craigastevens@westbrookstevens.com
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PART I : Incoming Patients Applicable Lean Principle : Consistent incoming patient flow
Incoming patient flow and trend
Hospital Service
Patient Admissions
Doctor’s Office/ Department
Incoming Patients
PART I : Incoming Patients Applicable Lean Principle : Consistent incoming patient flow
Incoming patient flow and trend
Hospital Service
Patient Admissions
Doctor’s Office/ Department
Incoming Patients
gaganrajpal1@gmail.com
Is there any “trend� in number incoming patients over the years?
Number of patients in year 2007 & 2010 are extrapolated
gaganrajpal1@gmail.com
Is there any “trend� in number incoming patients over the years?
gaganrajpal1@gmail.com
Is there any “trend” in “number” of incoming patients within an year?
gaganrajpal1@gmail.com
Is there any “trend” in “type” of incoming patients within an year?
gaganrajpal1@gmail.com
Is there any “trend” in “number” incoming patients within a week?
gaganrajpal1@gmail.com
Is there any “trend” in “type” of incoming patients within a week?
Is there any “trend” in “number & type” of incoming patients within a day?
Agenda Creating a Team Focused Improvement Program
✓
1
Goals/Objectives
✓
2
General PI Processes
✓
3
PI Assessment and Performance Measures
✓
4
Process Analysis
5
Layout Analysis and Spaghetti Diagrams
6
Value Chain Analysis
7
SPIOC
8
Summary of PI Program Approach
craigastevens@westbrookstevens.com
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PART II : Patient Admission Applicable Lean Principle : Efficient, effective and reliable admissions process Is staffing logistics appropriate? Is patient registration a smooth process?
Current layout
Hospital Service
Patient Admissions
Doctor’s Office/ Department
Incoming Patients
PART II : Patient Admission Applicable Lean Principle : Efficient, effective and reliable admissions process Is staffing logistics appropriate? Is patient registration a smooth process?
Current layout
Hospital Service
Patient Admissions
Doctor’s Office/ Department
Incoming Patients
Step 2 –Assessment Phase
A= Assessments
P = Problem Solving
I = Implementation Using Project Management Tools/Support
craigastevens@westbrookstevens.com
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Is staffing logistics appropriate?
gaganrajpal1@gmail.com
Is staffing logistics appropriate? 3-4 registrations/ hr
Temporary solution will be to move one of the evening personnel to the peak hours gaganrajpal1@gmail.com
Is patient registration a smooth process? Doctor’s Office
Rarely on Order Pre-Cert #
Bad Faxes Order
Patient Registration Patients Name
No Order
Not having insurance card
Date of birth Diagnosis
No diagnosis on order
Tests to be done
Interpreter
Grand parents or Neighbors Step parents
Doctor’s Sign Legal guardianship
No signature Legal guardianship paper
House Address
gaganrajpal1@gmail.com
Is patient registration a smooth process? (Continued)
Doctor’s Office/ Department
gaganrajpal1@gmail.com
Step 3 – Build the Problem Solving Portfolio A= Assessments
P = Problem Solving
I = Implementation Using Project Management Tools/Support
craigastevens@westbrookstevens.com
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Recommendations Pre-screening orders and have more proactive approach Creating a Kanban system for orders that need attention Having Pre-cert # already on the order Having a “complete” & “readable” order Better fax machines “Standard format” for orders (Website access to input patient data) • No need for faxes • Direct upload onto the database • Can be easily read • Time & Money saved
Pre-registration on phone In case of surgery, doctor could send order directly to surgery In case of standing order, direct admit
gaganrajpal1@gmail.com
Agenda Creating a Team Focused Improvement Program
✓
1
Goals/Objectives
✓
2
General PI Processes
✓
3
PI Assessment and Performance Measures
✓
4
Process Analysis
✓
5
Layout Analysis and Spaghetti Diagrams
6
Value Chain Analysis
7
SPIOC
8
Summary of PI Program Approach
craigastevens@westbrookstevens.com
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The current layout
1.4 Miles/ shift
gaganrajpal1@gmail.com
Recommendations Change the current layout
Apply principles 5 S in patient admissions office Sort (Seiri), Straighten (Seiton), Shine (Seiso), Standardize (Seiketsu) and Sustain (Shitsuke) gaganrajpal1@gmail.com
Step 6 – Select the Solutions and Build a Project Portfolio A= Assessments
GFR GFR
GFR P = Problem Solving
I = Implementation Using Project Management Tools/Support
craigastevens@westbrookstevens.com
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The “new” layout
The “current” layout
Fax Room
Marty’s Office
4
3
2
1
Front Desk
Call Center
gaganrajpal1@gmail.com
The Achievable Target 5-6 registrations/ hr
Agenda Creating a Team Focused Improvement Program
✓
1
Goals/Objectives
✓
2
General PI Processes
✓
3
PI Assessment and Performance Measures
✓
4
Process Analysis
✓
5
Layout Analysis and Spaghetti Diagrams
✓
6
Value Chain Analysis
7
SPIOC
8
Summary of PI Program Approach
craigastevens@westbrookstevens.com
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PART III : After Admission Lean Principle Applicable : Customer satisfaction due to the reduction in wait time via Just In Time system/ pull system Patient flow Alignment between admissions & services provided
Resource Allocation
Hospital Service
Patient Admissions
Doctor’s Office/ Department
Incoming Patients
PART III : After Admission Lean Principle Applicable : Customer satisfaction due to the reduction in wait time via Just In Time system/ pull system Patient flow Alignment between admissions & services provided
Resource Allocation
Hospital Service
Patient Admissions
Doctor’s Office/ Department
Incoming Patients
Step 2 –Assessment Phase
A= Assessments
P = Problem Solving
I = Implementation Using Project Management Tools/Support
craigastevens@westbrookstevens.com
40
Focus Areas
gaganrajpal1@gmail.com
Focus Areas
gaganrajpal1@gmail.com
Value added Vs Non-value added time • Patient registration • Explaining the procedure • Taking history • Actual procedure
• Redundancy • Waiting • Walking/ transportation • Excessive processing • Errors
gaganrajpal1@gmail.com
3/11/2013
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3/11/2013
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3/11/2013
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3/11/2013
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3/11/2013
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Types of waste Redundancy in paper work Waiting for technician Waiting for room Same questions asked by several personnel Orders lost
Delay in bringing patients from the floor lack of transporter technician being busy with other patients sometimes lack of technicians gaganrajpal1@gmail.com
3/11/2013
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Agenda Creating a Team Focused Improvement Program
✓
1
Goals/Objectives
✓
2
General PI Processes
✓
3
PI Assessment and Performance Measures
✓
4
Process Analysis
✓
5
Layout Analysis and Spaghetti Diagrams
✓
6
Value Chain Analysis
✓
7
SPIOC
8
Summary of PI Program Approach
craigastevens@westbrookstevens.com
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PART IV : Resource allocation model
Resource Allocation
Hospital Service
Patient Admissions
Doctor’s Office/ Department
Incoming Patients
gaganrajpal1@gmail.com
PART IV : Resource allocation model
Resource Allocation
Hospital Service
Patient Admissions
Doctor’s Office/ Department
Incoming Patients
gaganrajpal1@gmail.com
Step 3 – Build the Problem Solving Portfolio A= Assessments
P = Problem Solving
I = Implementation Using Project Management Tools/Support
craigastevens@westbrookstevens.com
54
Allocation of resources to patient admissions
1. To increase service/ patient satisfaction 2. To minimize cost Depends on- Number of people - Time/ Schedule of different departments
gaganrajpal1@gmail.com
Our approach
SIPOC Supplier
Input
Department
Patient -Time
- Doctor
- Schedule
Process Admissions to the entrance of the service
Output Customer Service -Time
Patient
- Quality
Logic : Ability to provide resources to serve the customer Resources are provided in the process, therefore, they should dictate the schedule gaganrajpal1@gmail.com
Input • • • • • •
Insurance Order Relation to Patient Social Security # Address Doctor’s name
• Service Required • Availability of service • # of patients in queue for service • Avg. time required for service
Output Type - 1
X-ray
QS1
QS11 Type - 2
Pulmonary
QS12
QS2
Patient
Admissions
QA
Type - 3
Lab
QS3
QS13 Type - 4
Neurology
QS4
QS14 Surgery
QS5 Type - n
QS1n
Output = Min: ∑ QA + QS1 + QS11 --------------
Allocation of resources to patient admissions
1. To increase service/ patient satisfaction 2. To minimize cost Depends on- Number of people - Time/ Schedule of different departments
gaganrajpal1@gmail.com
Our approach
SIPOC Supplier - Department - Doctor
Input Patient -Time - Schedule
Process Admissions to the entrance of the service
Output Service -Time
Customer Patient
- Quality
Logic : Ability to provide resources to serve the customer Resources are provided in the process, therefore, they should dictate the schedule gaganrajpal1@gmail.com
Input • • • • • •
Insurance Order Relation to Patient Social Security # Address Doctor’s name
• Service Required • Availability of service • # of patients in queue for service • Avg. time required for service
gaganrajpal1@gmail.com
Output Type - 1
X-ray
QS1
QS11 Type - 2
Pulmonary
QS12
QS2
Patient
Admissions
QA
Type - 3
Lab
QS3
QS13 Type - 4
Neurology
QS4
QS14 Surgery
QS5 Type - n
QS1n
Output = Min: ∑ QA + QS1 + QS11 -------------gaganrajpal1@gmail.com
Agenda Creating a Team Focused Improvement Program
✓
1
Goals/Objectives
✓
2
General PI Processes
✓
3
PI Assessment and Performance Measures
✓
4
Process Analysis
✓
5
Layout Analysis and Spaghetti Diagrams
✓
6
Value Chain Analysis
✓
7
SPIOC
✓
8
Summary of PI Program Approach
craigastevens@westbrookstevens.com
63